From diagnosis to decision-making: the evolving role of biomarkers in acute pancreatitis

Abstract

Acute pancreatitis (AP) presents clinicians with a fundamental challenge: while the majority of patients recover with minimal intervention, a significant minority deteriorate rapidly, developing organ failure and life-threatening complications. Early identification of high-risk patients remains one of the most clinically important and unresolved problems in AP management. This narrative review examines how biomarkers have evolved beyond their traditional diagnostic role to become integral to early risk stratification and therapeutic decision-making in patients with AP. We adopt a time-dependent, clinically integrated perspective to bridge the gap between pathophysiological insights and bedside practice. A structured search of PubMed and Embase databases was conducted covering publications from 1998 to 2025. Approximately 120 articles were screened, and 58 were selected based on relevance, methodological quality, and clinical applicability. Traditional markers (CRP, procalcitonin) retain meaningful prognostic utility but are constrained by delayed rises and limited specificity. Early cytokines — notably IL-6 and IL-15 — offer superior sensitivity within the first 24 h. Emerging biomarkers, including growth differentiation factor-15 (GDF-15) and pentraxin-3 (PTX-3), may outperform conventional scoring systems at admission. Biomarkers also inform therapeutic decisions in hypertriglyceridemia-associated AP, biliary AP requiring ERCP, and suspected infected pancreatic necrosis. A pragmatic, time-dependent integration of molecular biomarkers with clinical scoring systems offers the most realistic pathway toward personalized management of AP. The greatest clinical value of biomarkers lies in refining clinical judgment during the earliest and most critical phases of the disease.